All types of breast implants have an outer, silicone shell that can potentially develop a tear or hole called a rupture. A saline implant also has a valve that can fail, causing a leak. The chance that your implant will rupture or leak increases over time.
Causes, signs, and symptoms of a ruptured breast implant
Implant rupture can happen because of normal aging of the implant, trauma caused by a car accident, a needle insertion during a biopsy, or other factors. In a 2013 study, researchers looked at device-retrieval data from the implant manufacturers Mentor and Allergan and found that 51 to 64% of silicone implant ruptures were caused by damage by surgical instruments during the initial implant surgery.1
When a saline implant ruptures or its valve fails, the saline leaks out quickly — typically over the course of a few days — and the breast appears somewhat deflated, so you know immediately that it's ruptured. The salt water is absorbed by the body.
When a silicone implant ruptures, the gel leaks out more slowly because it's thicker, so it may take you longer to realize that the implant has ruptured, or you may not realize it at all. Silicone gel is not absorbed into the body.
The liquid silicone gel implants sold in the United States prior to 1992 are more likely to leak beyond the capsule of scar tissue surrounding the implant if a rupture occurs. The liquid silicone gel can spread to other parts of the body, such as the lymph nodes or the lungs. Your body may react to the silicone by forming more scar tissue, which might be uncomfortable or cause a distorted breast shape. In relatively rare cases, lumps called silicone granulomas can form in the arm, armpit, chest area, or elsewhere in the body.
Starting in 2006, the silicone implants sold in the United States have had thicker shells and a more cohesive gel filler. If these implants rupture, they tend to get a tear in the shell (also known as a “gel fracture”), which can compromise the shape and appearance of the implant.
Signs that your silicone implant has ruptured can include changes in breast shape and size, and increasing pain, firmness, and swelling over a period of weeks. Rupture can also cause capsular contracture. Silicone implant rupture that doesn’t cause any noticeable symptoms is known as “silent rupture.”
Screening for breast implant rupture
The FDA recommends that people with silicone breast implants receive MRI screening for “silent rupture” 3 years after the initial implant surgery and every 2 years after that. Getting health insurance to cover this can be challenging, so you may have to work with your doctor’s office on this.
If at any time you think your implant may have ruptured, have your plastic surgeon check it. An imaging test, such as an ultrasound or MRI, can help determine whether an implant is leaking. An MRI (with equipment designed specifically for imaging the breast) is widely considered the most accurate imaging test for this purpose. However, as with any imaging test, there’s some risk that the results will not be accurate — a rupture may not show up or an intact implant may appear to be ruptured on an MRI.
Corrective surgery for breast implant rupture
When a saline or silicone gel-filled implant has ruptured, the implant should be surgically removed. In some cases, your plastic surgeon will also remove the capsule of scar tissue surrounding the implant or just cut open the capsule by making small incisions.
If you have implants in both breasts, your plastic surgeon will in most cases remove both of them, even if only one has ruptured. If you have a silicone implant that has leaked beyond the capsule, your plastic surgeon will remove the silicone that has leaked out.
Usually if you’ve decided that you want new implants, your surgeon can insert them during the same surgery. In some cases, your surgeon may recommend that you switch to a different type of implant.
Another option may be to have your breast(s) reconstructed with a flap of tissue taken from another place on your body (“autologous reconstruction”) rather than getting new implants. With an autologous reconstruction, you won’t have any risk of a rupture in the future or of the other complications that can develop with implants. However, autologous reconstruction involves a more complex, time-consuming surgery and a longer recovery time. Learn more about autologous reconstruction.
- Handel N, et al. Breast implant rupture: causes, incidence, clinical impact, and management. Plast Reconstr Surg. 2013;132:1128-37. Available at: https://www.ncbi.nlm.nih.gov/pubmed/24165596